"If everyone knew how to run PDSA cycles, whenever . . . we see an opportunity to make something better, we would . . . say, 'Let’s run a test and learn.'"

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Why You Should Be Curious about PDSAs

By Karen Baldoza | Tuesday, March 3, 2015

Just over six months ago, IHI’s President and CEO Maureen Bisognano posed a question to my colleague and me, “What is the one improvement idea everyone in health care should know?” My colleague and I quickly started brainstorming ideas — the Model for Improvement, Deming’s System of Profound Knowledge, systems thinking, lean thinking, change concepts, the forms of waste, and so on.

Maureen continued, “Let me push you a bit more. If we were to have something go viral to everyone in the world, what should it be?” Oh, well if it will be viral, it has to be much more concise and concrete, so we focused on tools — run charts, flowcharts, Pareto charts, and the list went on.

Though Maureen’s questions were provocations to get us thinking beyond our current boundaries, it stuck with me: What is the one improvement idea everyone should know?

Now, I’m the mother of two young boys and one day I found myself saying to my older son, “Honey, I know you’re frustrated that the Lego tower won’t stand up, but throwing the blocks won’t change that. Let’s try again. What can we try to help it stand up this time?” And it came to me — PDSA, testing ideas through Plan-Do-Study-Act (PDSA) cycles, that’s the improvement idea I would want everyone to know!

What is a PDSA cycle? You can read more about the Model for Improvement and PDSAs on IHI’s website, but briefly, the PDSA cycle is shorthand for testing a change — by planning it, trying it, observing the results, and acting on what you learn. It is the scientific method, used for action-oriented learning in real-life situations. It is common to all improvement methodologies.

As The Improvement Guidestates, PDSA is a “cycle that can be used to turn ideas into action and connect action to learning.” For me, this simple “vehicle for learning and action” encourages us to approach the world, change, and others with a sense of curiosity, optimism, and progress instead of frustration, despair, and inertia. It merges systems thinking, learning, variation, and human behavior in one simple tool. Anything is possible with this approach: just test a change and learn your way forward.

The more I thought about this, the more it made sense to me. I started to see the power of testing change ideas through PDSA cycles among my colleagues at IHI through our own improvement efforts. I’ve had the privilege of watching staff test ideas everyday — to determine which steps in our processes add value to customers and which do not, to improve how we bring new programs to customers and better match programs to our customers’ priorities, to identify how we can reduce costs, raise our own productivity, and even how we onboard new staff and increase our joy in work.

One internal team improved IHI’s IT systems (which, by the way, had more to do with process changes than actual changes in the technology!) by looking at standard processes for using our IT systems across roles and departments, standardizing roles and responsibilities, reducing the number of options and variation, and using defaults and standard drop-downs. We currently have a team looking at how to most effectively communicate with customers through email — what’s the best day of the week to send a message, time of day, length and content, sender. The learning and power that comes from the PDSA approach is energizing, each of us able to see a challenge or an opportunity and do something about it on a daily basis.

I’ve even observed that many, if not most, children’s shows are based on this trial-and-learning approach. With two young children, I am very familiar with Curious George, the good and always very curious monkey; between the books and toys and television shows, he’s almost like a third son in my house. The plot of most of the TV episodes is George trying to figure out how to fix, learn, or improve something. “School of Dance” happens to be one of my favorites, where George is trying to figure out a way to teach his friend Bill how to dance. Through several iterative cycles of testing — placing footprints on the floor to show the dance steps, making the footprints different colors to differentiate the right foot from the left one, numbering the footprints in the order of the steps, taping the footprints to the floor so they don’t move around — George figures out how to teach Bill and others how to dance.

Running PDSA cycles comes naturally. Children use the PDSA approach all the time, without even knowing it. You use it, too. Have you ever tried to take a different route to work to see if there was less traffic, tried to exercise more, tried to learn how to use your new smartphone, tried to learn a new hobby, or tried to get a baby to sleep through the night? Then you’ve been running PDSA cycles. We’re teaching it to students in IHI’s Open School courses. Now can we expand the PDSA approach beyond ourselves to interactions with others at work, maybe even in our families, amongst our friends, and in our communities? How can we make it go viral?

What if everyone in the world knew how to run PDSA cycles and approached change through this lens? Could you imagine the evening news? “Community clashes over XYZ issue, but decided to run a series of tests to learn what solution will work best in our town.” Yes, we can learn what happened in this community and that community, but testing through PDSA cycles helps us determine what’s going to work in our community, in our local context.

If everyone knew how to run PDSA cycles, whenever something doesn’t go as planned, people have differing opinions on how to proceed on some issue, or we see an opportunity to make something better, we would get out of the conference room or the debate and say, “Let’s run a test and learn.”

Perhaps that’s a bit of a stretch, but I’m testing this approach now with my children with everything from building Lego towers, to using the potty, to our morning routine so we can get out of the house faster. I’ll let you know how it goes.

So, PDSA cycles is my answer to Maureen’s question, “What is the one improvement idea you think everyone in the world should know?” What would be your answer?

Karen Baldoza is an Executive Director at IHI who is engaged in IHI’s work on building improvement capability.

The Institute for Healthcare Improvement (IHI), Improvement Advisor Professional Development Programme helps individuals in this critical role build and hone high-level improvement skills. This richly-packed, 10-month programme is an “all teach, all learn” experience.

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